An Iraqi boy awaits medical treatment in the emergency room at Yarmouk Hospital in Baghdad, Iraq, on September 28, 2006. Psychiatrists here are warning of a disturbing spike in mental health disorders among Iraq�s population, particularly children, as terrorism, an armed insurrection, and a bloody sectarian divide has gained a stranglehold on the country and its people. The escalating psychiatric caseloads are compounded by Iraq�s lack of mental health workers, facilities, and services leaving many people throughout the country with little or no treatment. The striking imbalance between the ongoing violence in Iraq and deficiencies in its mental health care system has triggered alarm among Iraq�s psychiatrists who said the consequences may permanently damage generations of this distressed nation. James Palmer / Special to The Chronicle Ran on: 03-19-2007
An Iraqi boy awaits treatment in the emergency room at Yarmouk Hospital in Baghdad. A study of 10,000 primary school students found at least 70 percent suffered from trauma-related symptoms.
Ran on: 03-19-2007
An Iraqi boy awaits treatment in the emergency room at Yarmouk Hospital in Baghdad. A study of 10,000 primary school students found at least 70 percent suffered from trauma-related symptoms.

2007-03-19 04:00:00 PDT Baghdad -- Iraqi psychiatrists are seeing what they call a disturbing spike in mental health disorders as the war passes its fourth anniversary -- a problem compounded by Iraq's lack of mental health workers, facilities and services.

Several mental health care professionals suggest the number of untreated or under-treated people nationwide reaches into the millions, and the consequences could permanently harm generations.

"Iraqis are being traumatized every day," said Dr. Said al-Hashimi, 54, a psychiatrist who runs a private clinic and teaches at Mustansiriya Medical School in Baghdad. "No one knows what will result from living through this continuous trauma on a daily basis."

The government-run Ibn Rushd psychiatric center in the Iraqi capital provides examples of damaged people looking for help.

In a sparsely furnished office inside the hospital, Iraqis file in to describe their ailments to Dr. Haider Adel Ali, a somber 40-year-old psychiatrist.

Fanzia Jaafer, a 65-year-old housewife, has suffered from severe depression and suicidal thoughts since viewing the corpse of her son, whose head was nearly torn off by gunfire late in 2003.

Sundes al-Dulaimi, 27, said she has endured chronic headaches, insomnia, loss of appetite and panic attacks after the slaying of her 55-year-old father by a Shiite militia in June.

Zaman al-Keelany, 15, has experienced flashbacks of a rocket destroying a building in her neighborhood. The high school freshman said she has managed to continue her studies, but breaks down whenever she hears a loud noise.

Though no reliable research exists on the state of Iraqis' mental health, the preliminary results of a survey of 10,000 primary school students in the Shaab section of north Baghdad, conducted by the Iraqi Society of Psychiatrists and the World Health Organization, reveals widespread problems.

The study, not yet published, found at least 70 percent of students were suffering from trauma-related symptoms, according to Mohammed al-Aboudi, Iraq's national mental health adviser. Aboudi said those numbers appeared so high that the survey was redone -- only to come up with similar results.

Ten-year-old Ahmed al-Dulaimi (no relation to Sundes al-Dulaimi) is one of the young Iraqis struggling to function.

Computer-savvy Ahmed, who enjoys playing soccer, stopped talking and refused to eat or drink when his family moved last year from their west Baghdad home to Fallujah for three months. They had moved after receiving a threatening letter with a bullet enclosed.

They have returned home and say Ahmed's condition is improving. But the boy is continuing psychiatric treatment at Ibn Rushd as an outpatient, and Ali has prescribed antidepressants while advising the boy's family to prevent him from watching violence on television.

"We're now finding an elevation of mental health disorders in children -- emotional, conduct, peer, attention deficit," Hashimi said. "A number are even resulting in suicide."

For some Iraqi doctors, the increase in the number of children traumatized by violence is apparent at the workplace and at home.

"I look into the eyes of children whose parents have been killed or are imprisoned every day," said Dr. Nadal al-Shamri, a pediatrician at the Medical City health complex in Baghdad. "The psychological trauma is so deeply ingrained in some children that they may never lead a normal life."

Al-Shamri said his 7-year-old son suffered an apparent nervous breakdown last year and stopped eating after the slaying of a close friend's father.

"It's difficult for me to eat after watching him cry," al-Shamri said.

Iraqi psychiatrists, like most medical professionals here, are suffering from training and funding shortages. No psychotherapy or crisis centers exist, and Ibn Rushd is the only psychiatric hospital in the capital of 6 million people.

Patients at Ibn Rushd receive free treatment and medication, but those who can afford care at a private clinic pay roughly 5,000 Iraqi dinars -- nearly $4 -- for visits that usually last 30 minutes to an hour.

A shortage of prescription medication has resulted in a Health Ministry order limiting treatments to 10 days.

There is a similar shortage of psychiatrists, who have been among the professionals and intellectuals leaving Iraq in response to a campaign of intimidation.

Mental health adviser al-Aboudi, who also heads the Iraqi Society of Psychiatrists, estimates at least 140 of the country's 200 psychiatrists have been killed or have fled during the past four years.

Ali, who earns $300 monthly, is determined to remain, and he has the scars to prove his courage: two bullet wounds in his right arm from an assassination attempt in his clinic last year.

Remarking on Iraq's diminishing psychiatric resources, Ali said, "There is little interest from the government. We ask for training and assistance with (creating psychiatric) centers, but get nothing."

While consulting a string of patients one morning last month, Ali offered advice, prescriptions and, perhaps most important, compassion.

Jaafer, the housewife with suicidal thoughts, was cloaked in a traditional black abaya and clutched a white tissue in her right hand as she sat on a chair adjacent to Ali's desk and described the difficulties of coping with the killing of her 29-year-old son, Haider, more than three years ago. "Whenever I remember seeing his body at the morgue, I start to cry," said Jaafer, who complained of insomnia and losses of memory and appetite.

To make matters worse, Jaafer said, her family provides no support or sympathy. "They don't believe I'm really suffering," she said. "They just tell me to stop crying."

Ali looked down at his desk and paused for a moment to let Jaafer wipe the tears.

"We have all lost a dear one -- you should try to speak to other women who have lost their children," he said, before writing her a prescription for Valium.

That's about the best someone like Jaafer can hope for during a visit to the hospital. Anyone who wants or needs other psychiatric treatment "must go abroad," Ali said.

With no end to Iraq's troubles on the horizon, mental health professionals say the entire population eventually will require some type of healing. Hadoon Waleed, a psychology professor at Baghdad University, painted a grim picture when questioned about the future.

"Within five years of the falling of the regime, all Iraqis will be traumatized," he said. "We will all need treatment."